Sri Lanka donates eyes to the world

At 10:25 a.m., a dark brown eye was removed from a man whose lids had closed for the last time. Five hours later, the orb was staring up at the ceiling from a stainless steel tray in an operating room with two blind patients —both waiting to give it a second life. S.P.D. Siriwardana, 63, remained still under a white sheet as the surgeon delicately replaced the cornea that had gone bad in his right eye following a cataract surgery. Across the room, patient A.K. Premathilake, 32, waited for the sclera, the white of the eye, to provide precious stem cells and restore some vision after acid scalded his sight away on the job. ”The eye from this dead person was transplanted to my son,” said A.K. Admon Singho, who guided Premathilake through the hall after the surgery. ”He’s dead, but he’s still alive. His eye can still see the world.” This gift of sight is so common here, it’s become an unwritten symbol of pride and culture for Sri Lanka, an island of about 20 million people located off the southern coast of India. Despite recently emerging from a quarter century of civil war, the country is among the world’s largest cornea providers. It donates about 3,000 corneas a year and has provided tissue to 57 countries over nearly a half century, with Pakistan receiving the biggest share, according to the nonprofit Sri Lanka Eye Donation Society. The organisation began promoting eye donation decades ago, but has since faced allegations of mismanagement and poor quality standards.The supply of corneas is so great in Sri Lanka that a new, state-of-the-art government eye bank opened last year, funded by Singapore donors. It has started collecting tissue from patients at one of the country’s largest hospitals, hoping to add an additional 2,000 corneas to those already shipped abroad annually. Nearly 900,000 people have also signed up to give their eyes in death through the Eye Donation Society’s longstanding eye bank. ”People ask me, ‘Can we donate our eyes while we are living? Because we have two eyes, can we donate one?”’ said Dr. Sisira Liyanage, director of Sri Lanka’s National Eye Hospital in the capital, Colombo, where the new eye bank is based. ”They are giving just because of the willingness to help others. They are not accepting anything.” The desire to help transcends social and economic barriers. Prime ministers pass on their corneas here along with the poorest tea farmers. Many Sri Lankans, about 67 per cent of whom are Buddhist, believe that surrendering their eyes at death completes an act of ”dana,” or giving, which helps them be reincarnated into a better life. It’s a concept that was first promoted a half century ago by the late Dr. Hudson Silva, who was frustrated by the massive shortage of corneas in his native Sri Lanka. Most eyes back then were harvested from the handful of prisoners hanged each year, leaving little hope for blind patients in need of transplants. Silva wrote a newspaper piece in the late 1950s pledging to donate his own corneas and appealing to readers to also give ”Life to a Dead Eye.” The response was overwhelming. With no lab facilities or high-tech equipment, he and wife Irangani de Silva began harvesting eyes and storing them in their home refrigerator. They started the Eye Donation Society, and in 1964, the first cornea sent abroad was hand-carried in an ice-packed tea thermos aboard a flight to Singapore. Since then, 60,000 corneas have been donated. While the Society’s eye bank was a pioneer, questions about quality emerged as international eye banking standards improved over the next 20 to 30 years. Concerns have recently been raised about less advanced screening for HIV and other diseases, and the eye bank has also faced allegations of mismanagement. Many of its corneas are harvested from the homes of the dead in rural areas across the country, making auditing and quality assurance levels harder to maintain, said Dr. Donald Tan, medical director of Singapore National Eye Center, who helped set up the new eye bank. Once, he said, a blade of grass was found packaged with tissue requested for research. Eye Donation Society manager Janath Matara Arachchi says the organization sends ”only the good and healthy eyes” and has not received a complaint in 20 years. Arachchi said the organisation checks for HIV, hepatitis and other sexually transmitted diseases by dipping a strip into blood samples and waiting to see if it changes color for a positive result. Sri Lanka’s Health Ministry also said it has received no complaints about the eye bank from other countries. Medical director Dr. M.H.S. Cassim denied that anyone from the organization is making money off donations sent abroad. He said they charge up to $450 per cornea to cover operational costs and the high price of preservatives needed to store the tissue.